Up to the number of the most important injuries. The stench adds up to 3-18% of the total number of injuries, and in the middle of them 20-30% - the same ushkodzhennya. With such poshkodzhennyah often posterіgaetsya shock of various stages, confusion mainly massive internal bleeding. Navit in spetsializovanih traumatologicheskih frequency of unsatisfactory results in the treatment of similar poshkodzhenya reaches 20-25% and can not be particularly tendencies to decrease. Such a large number of unsatisfactory results are due to the general feasibility of conservative methods, which are the main fractures in the treatment of pelvic cysts with multiple and subsequent injuries due to an important state of suffering and the need for resuscitation they go to that intensive therapy. Invalidity after conservative likuvannya to become 30-55%. This is bound up with the feasibility of repositioning the vіdlamkіv and matrimony їх in the correct position for the entire period of jubilation, the impossibility of carrying out an early functional jubilation. In addition, a short-term method is trivaliy in the recovery of an ailing person in a lie, which often reduces the development of thromboembolic and septic conditions, atrophy of malignancies, and also makes it easier to watch for ailments, especially with multiple ailments jenny. At the same time, the topical diagnosis of posterior cysts and congestion of the pelvis presents significant difficulties, about which the frequency of clinical and pathoanatomical diagnoses is as high as 42-54%. As a rule, the greatest number of undiagnosed ears is caused by injuries of the posterior vertebrae (bichni masi krizhiv, krizhovo-klubovoy suglom) of the pelvic ring.

A significant number of traumatologists in the treatment of such ailments are divided into 2 periods: gostry, in which the treatment is directed at the order of life of the ailing, and in the past, meta, such as the correction of the misalignment of the ulama of the pelvic bones.

Given both the country's and foreign literature, it is ambiguous to talk about those that the progress of the achievements of those who suffered from such injuries was the main rank in the first period and in the smaller world - in another, more important. For the rest of the decade, the lethality due to shock and bleeding in case of folded fractures of the pelvis decreased even more and became 10-12%. The results of the primary treatment and rehabilitation of ailments with foldable pelvic folds are lower, and the disability is 20-25%.

As a result of inconsistent susvation of the pelvic cysts, there are stable static-dynamic and neurological disorders, which are accompanied by a pronounced pain syndrome and sometimes often relieve ailments. At the present time, the literature may not list the need for an accurate indication of treatment for fractures and fractures of the pelvis, however, there is a thought that there is no new fallow between the stage of anatomical restoration of the pelvic ring and functional heritage kami. With such a thought, if you want to often, wait, then it’s obvious that all the static-dynamic discords are due to the consequences of non-existent anatomical changes and, on the contrary, if the pelvis is damaged without displacement, it’s rare.

In the rest of the years in the clinics of CITO in case of treatment of ailments with fractures of the pelvic bones, it is possible to successfully develop thorough methods, for the help of which they restore the pelvic ring in depressions, if the traditional methods of treatment are insufficiently effective. When choosing the method of healing, ailments are healed for a century, a profession, a cold camp, the nature of concurrent injuries of the pelvis of the ear, localization and steps of the displacement of the cystic ulamkiv, the presence or absence of the ear of the pelvis. When treating uncomplicated fractures of the pelvic bones, it is easy to classify A.V.

I. Fracture the pelvic bones, so as not to take part in the abduction of the pelvic ring:
1) anterior fractures of the upper and lower anterior spines of the club cyst;
2) late and transverse fractures of the krill of the club cyst;
3) fractures of crises in the zone, which do not take part in the criss-club junction;
4) fractures of coccygeal ridges.

II. Fracture the pelvic bones without damaging the stability of the pelvic ring:
1) unilateral or bilateral fracture of the sidnic cyst;
2) unilateral or bilateral fracture of one hilar of the pubic cyst;
3) fracture of the neck of the pubic cyst on one side and sidnic - on the other side.

III. Fracture of the pelvic ring with impaired stability and expansion of the articulation:
A. Anterior joint: 1) unilateral and bilateral fractures of both pubic cysts; 2) unilateral and bilateral fractures of the pubic and sidnic cysts (in the panicle form);
3) expand the pubic symphysis.
B. Posterior joint: 1) late fracture of the club cyst;
2) raising the krizhovo-club swamp.
B. polyfocal fractures of the anterior and posterior pelvic rims: 1) unilateral and bilateral vertical fractures of the Malgen type; 2) diagonal fracture; 3) the difference between fractures of the bones and the development of the pubic symphysis and the krizhovo-club swamp.

IV. Break the swivel trap:
1) fracture of the acetabulum with and without vivihu stegna, including transacetabulation.

Fallow in specific conditions (expression of blood loss, susceptibility or susceptibility to internal organ failure, etc.) whom I will become A factor that directly influences the result of pelvic injuries is the need for pre-hospital care at the hospital, as well as the hour of transportation of the victim to specializations. A number of emergency medical visits (for various types of blockades, infusion therapy, the introduction of hemostatic drugs, etc.) ovoї terapії, zabіgає secondarily zmіschennya kіstkovykh ulamkіv, spryає sparing transportvanni z mіstsya podії v the liquor, and then during the period of rebuking the sick in the intensive care unit.

Transport immobilization. For the immobilization of the pelvis, the splits are pulled together by a belt-bandage, which ensures the protection of the skin of the bones of the bones and allows for portability, small weight, and the strength of the arm (Fig. 8.1). The belt is folded from the mother's part (cloth type cloth), which is superimposed on the back surface of the pelvis and krizhiv; shkiryanoy parts, like hoisting the pelvis in front and from the sides, and straps with a sticky edge, signs for attaching the pelvic bandage to the ailment. If necessary, the pelvic girdle will fit well with tires for transport immobilization of the upper and lower ends; vikoristannya belt allows you to viroblyat radiological follow-up of the injured, not afraid of relapse of shock and bleeding; in the distant belt you can wink for jubilant purposes. Transportation of the injured must be carried out on a stretcher, the shield of which is to be made from radio-opaque material. Tse in the future helps in the need for shifting ailments from burdens to the table and back at the hour of the X-ray examination.

The important nature of the occasion dictates the need to continue protishokovoї therapy and resuscitation visits, initiated by traumatologists of a specialized machine with the method of removing ailments from a dangerous state. Most of the victims who need to go to the clinic at an important or near

An important station, may have multiple and combined injuries - fractures of the bones of various segments in the musculoskeletal apparatus and damage to the internal organs, which can lead to the development of an important shock and terminal state. Vikoristanny of the pelvic girdle, as a result of transport immobilization, showed the onset of an attack:
- to spare the transportation of the injured to the likuval mortgage; sufficient zhorstkіst immobilization of the pelvis increases the effectiveness of anti-shock approaches, facilitating the treatment of ailments from shock;
- zavdyaki simplicity of the invoice quickly the term of the yogo service hour, necessary for vikonanniya ne vіdkladnyh zahodіv;
- if necessary, the pelvic girdle will fit well with tires, recognized for transport immobilization of the upper and lower ends;
- safe access, possibility of visual control, diagnostic and juvenile manipulations on traumatic fossae in case of repeated and multiple injuries;
- allows to perform X-ray follow-up of the injured without recurrence of shock and recurrence of bleeding.

Victims with multiple and lower pelvic injuries, as well as with isolated earaches, which were accompanied by a development of traumatic shock, were taken to the intensive care unit, and were kept until they were seen and the main life functions.

In the resuscitation department, anti-shock therapy should be carried out in a differentiated, safe way, so that the effectiveness of the juvenile approaches is determined by the correctness of the vision of the dominating shock, which hopes to have an uninterrupted impact on the result of the injury. However, don’t start seeing only one thing, let’s do it and dominating, let it be possible to do it purposefully and plan merrily come in, to be included in the complex of anti-shock therapy. Not enough of such a plan is the situation, which does not hurt the others, if not dominant, but the numerical ears, if they give mutually tight, one-on-one, and in the end, the result of an injury. Everything gave a hint that in case of multiple and repeated injuries of the pelvis, it is necessary to bend to the most recent and early manifestation of all apparent problems and appearance of them during resuscitation visits. Revealing the dominating ears makes it easier to resuscitate the victims and correctly orients them to the obligation of anti-shock and transfusion therapy.

Anti-shock therapy for pelvic isolation includes the use of analgesics, heart disease; to change the suppuration of impulses from the cavity of the ushkodzhennya, an intrapelvic novocaine blockade according to Shkolnikov-Selivanov should be carried out. The need for more intensive anti-shock therapy due to multiple failures of the musculoskeletal system. In these cases, additionally, novocaine blockade of multiple fractures, judicious immobilization of minor segments should be carried out.

Celebration of fractures of the pelvic bones and endings in the acute period, so you can go to another plan until the period, if the stabilization of the main life-saving functions of the organs is reached.

Diagnosis of pelvic auricles in the acute period of injury is complicated by an important incendiary camp of the injured, which will require resuscitation and anti-shock visits. In such cases, the evidence for a pelvic injury depends solely on the improvement of clinical data: external examination and palpation. They pay attention to the asymmetry of the cystic projections of the pelvic ring, the presence of hemorrhages in the soft tissues and pain during pressure or expansion of the krill of the club brushes, the width of the pubic symphysis and the tornness of the lateral fragment of the pelvis. Residual formulation of the diagnosis can be carried out after X-ray obstezhennya. Oglyadova roentgenogram of the pelvis may be of great importance for further tactics of extortion of ailments.

Traumatology and orthopedics
For the editorship of Corresponding Member RAMS
Yu. G. Shaposhnikova

understanding understanding

Ailments in the case of pelvic cysts are folded in 5% to 10% all traumatological diseases. Among the victims with multiple fractures, the stink becomes 3.3%, with the last earache - 25.5%. Fracture of the pelvic bones is visible to the most important organs of the musculoskeletal apparatus of people and is important in people of age 20-50. In the skin of the third victim with urticaria of the pelvis, a traumatic shock is caused. In case of multiple and subsequent fractures of the pelvis, an important part of the ailment is not only a neurogenic component of injury, as a result of teasing the great reflexogenic zones, but also an intense intratissue bleeding (up to 2.5 liters of blood). Quite often, the severity of clinical manifestations is marked by complications, to which one can see the shrinkage of internal organs.

Fracture the pelvic bones with the ears of the pelvic organs. In case of fractures of the bones of the pelvis, organs can be damaged, rotting in the small pelvis - sieve mіkhur, urethra, rectum, rarely pihvu, uterus and appendages. Most of all, they are afraid of the urethra and sich mihur. Damage to the visceral organs is associated with fractures of the pelvic bones in 10-28% in adults and in 7-8% in children.

Cause sickness. Mechanisms of vindication and development of illness (pathogenesis)

Fracture of the pelvis is blamed for compression in the sagittal or frontal plane. Such minds are created in case of crushing between the buffers of cars, walls and rickety transport, in case of landslides and blockages, filings from heights, road and transport conditions (naїzd transport zasobіv on a pedestrian) and in.

The most common are fractures of the anterior pelvis. The pelvic ring, styli, less in the midst of its elasticity, lamaetsya in the most thin and weak areas - the upper and lower pubic and sidnic brushes.

In most cases, unilateral fractures are expected. In case of fractures of the pubic and sidnic hilars, the cysts may form a "blizzard" and move to the back.

Thus, the injury is significant and the force is applied not only to the area of ​​the symphysis, but also to the krill of the club brush, it is necessary to open the ligamentous apparatus of the club-crystal articulation. In a number of depressions in the posterior aspect of the pelvic ring, a fracture of the club cyst was found.

Under the infusion of a shortened club-transverse m'yaz, square m'yazi across and oblique m'yazіv of the abdomen with vertical fractures of the anterior and posterior pivkiltsya of the pelvis of the ovnishnya ("vydirvana"), part of the pelvis is damaged by the burn.

The compression of the pelvis along the diagonal results in a fracture of the pelvic ring: on one side in the anterior joint - a fracture of the pubic and sidnic cysts, on the other side of the back - a vertical anterior club cyst.

A fall from the height on the side hump can lead to the vindication of a unilateral or bilateral vertical fracture of the pelvis and splinter fracture of the side hump.

Fracture the acetabulum and the central dislocation of the stegna is blamed when the pelvis is crushed on the side, when falling on the great birth or as a result of a strong direct blow.

Anterior fractures of the anterior-superior spine of the club cyst, the sidnichny tubercle are often blamed for running, playing football and other falls of the rapt and uncoordinated movement, which is more pronounced for the shortness of the m'yaziv.

Classification of fractures of the pelvis

From a practical point of view, the classification of A. V. Kaplan - L. G. Shkolnikov is easily corrected:

1. Critical fractures - fractures of the krill of the club cyst, krizhovo-club joint, kuprik, sidnichny tubercle, pelvic awns.

2. Break the bones of the pelvic ring without damage to its continuity: fractures of one or both of the pubic or lateral cysts;

3. Break the bones of the pelvic ring with damage to yoga stability:

Anterior joint - bilateral fractures of both hips of the pubic cyst; bilateral fractures of the pubic and sidnic cysts; unravel the symphysis.

Posterior joint - vertical fracture of the club cyst or krizhiv, opening of the krizhovo-club joint;

Fracture the anterior and posterior pelvis fractures with damage to the stability of only the anterior or posterior pelvis, or at the same time in both joints. Up to the whole group of fractures one can see:

Malgen's fracture- fracture of the pubic and sidnic cysts on one side and vertical fracture of the club cyst on the same side;

Voilemier fracture- vertical fracture of the creases and anterior pivkiltsya of the pelvis, as in the fracture of Malgenya, on the left side;

fracture none(Diagonal fracture of the pelvis) - vertical fracture of the club cyst from one side and anterior pivkiltsya - from the other side ;

Duvernay fracture- fracture of the posterior pivkiltsya with a fracture of the acetabulum.

4. Break the swivel trap - break the edge or the bottom of the trap, the central twist of the stegna.

5. Fracture of the pelvis and damage to the pelvic organs.

6. Combined care.

Clinical picture of illness (symptoms and syndromes)

Diagnosis for fractures of the pelvic bones is mainly based on the mechanism of injury, the diagnosis of the patient at the time of injury, the examination of the injured and palpation of the pelvis. Nesvidomy camp of the ailing, stunned by shock, internal bleeding and possible damage to internal organs, facilitating diagnosis. In a number of vibrations, difficulties may be associated with the inaccessibility of certain parts of the body for palpation. When looking at the ailing trace of memory, that a hematoma at the fracture site is not immediately visible, sometimes it manifests itself on the surface of the body through a sprat of a year or a day after the injury.

The typical posture of the victim: the legs are slightly bent in the knee and pelvic cramps, the lateral position is rotated (the "toad" position).

On palpation on the accessible pelvic organs (pubic, pelvic cysts, crest of the krill of the club cyst) the pain is exacerbated.

Important in the diagnosis of pelvic auricles, positive Verneuil's symptom: Intensified pain in the fracture at the pelvic cramps for the folds of the club brushes.

With some fractures, a positive Larrey's symptom: Bіl vinikaє in deeply rotting pelvic cysts when trying to open the pelvic cysts behind the anterior-upper spine.

The same important symptom in case of more fractures of the pelvis and damage to the support ability of the legs. Often there is a symptom of "sticky toe", like in case of fractures of the proximal part of the stegna.

The magnitude of the pelvic suture in fractures with damage to the continuity of the anterior and posterior pivkiltsya is determined by a path in the direction of the vertex of the sword-like growth of the sternum to the anterior-upper spine of the pelvis, or to the apex of one of the tassels.

In case of fractures of the pelvic bones, especially the posterior pivkiltsya, there are secondary hematomas, which can give a clinical picture of an acute abdomen (pseudo-abdominal syndrome). For a change in the pain syndrome and differential diagnosis of the organs of the empty stomach with a transverse hematoma, it is necessary to perform a mid-pelvic anesthesia according to Shkolnikov - Selivanov. As soon as the symptoms of teasing of the queue are avoided after anesthesia, then the next thing to do is to allow the collapse of the organs of the abdominal emptying and the need for laparocentesis.

Fracture the pelvic bones with the pelvic ear

Distinguish posture and internal open the cut michur.

Explore one by one often occur as a result of a change in the configuration of the pelvic ring and a sharp stretching of the ligaments, like fixing mihur. Rіdshe sich mіkhur to injure splinters of pelvic cysts. On addition to the clinical picture, fractures of the pelvis in the victim during the day of self-initiated sechovi- sion , wanting to save up to new savings. Self-sufficiency is possible. In this case, it is characterized by polyuria and a house of blood in the section. In the world, the development of sich infection is manifested by skarga on pain in the lower abdomen, liver and heaviness "in the depths" of the pelvis. At the same time, there are clinical signs of pelvic cellular infiltration: swelling (pastosity of tissues) over the pubis and inguinal ligaments, in the region of the crotch and the inner surface of the stegna; smoothing of the inguinal-scrotal fold and change of scalloped skin in designated areas from marmur to blue-red. Growing clinic of intoxication: rise in temperature up to 39 ° C and more with chills, tachycardia, severe aggravation of the inflamed state, leukocytosis appears in the blood due to the susceptibility of the formula to the left. The daily help can lead to the development of phlegmon.

internal poshkodzhennya they sound prominently seldom and blaming more importantly at a direct injection, sound at the repositioning of the sich mikhur (strike, fall from a height, transport injury). The most common is the front and back walls, de m'yazovy ball of smaller openings. At once, the line is opened, which covers the sich mіkhur, and I take care of the emptiness of the empty lace. At low openings of the sich mіkhur, the slash is zatіkaє into the empty stem of the shvidko. At the heights of high rises, the hitting of the cut into the empty cherevnina is even richer. On aphids, on pain in the lower abdomen and dysuric manifestations, approximately 10-12 years after injury, the patient develops and increases severe signs of peritonitis.

For urethra typical offensive clinical signs: cut-off; bleeding from the sinus canal; the test of sechoviprojection is accompanied by palpable pain; over the pubis palpate the re-pumping of the mesh mіkhur. Catheterization in these cases is contraindicated.

When looking around at all the victims of the pelvic ears, it is necessary to conduct a macroscopic and microscopic examination of the section. In times of acute zatrimka of the cut, as it can be reflex, catheterization of the cut michur is indicated. If there is a house of blood in the section, then X-rays of contrast are obtained to turn off the opening of the wall of the section mikhur. In the general order, sing two marks: with the overlapping and deformity of the sich michur, so that in case of opening the back wall on the radiograph with the contrast bridging with the contrast of the michur, it may not be revealed.

Open the rectum blamed for fractures of the pelvic bones significantly more. Distinguish the posture and internal pouch of the rectum. Pozaocherevinni poshkodzhennya manifested by the development of important phlegmon of the pelvic cell. For intraperitoneal ruptures, symptoms of peritonitis are characteristically developed. To exclude pathology from the side of the rectum, all those who suffer from a pelvic injury may need rectal finger examinations. For clarification of the diagnosis, a recto-colonoscopy can be performed.

The doctor, no matter what profile, hopefully to help the victim with fractures of the pelvic bones, in the obligatory order is guilty of turning off the damaged internal organs.

Poshkodzhennya internal organs in case of fractures of the pelvic bones to transfer this type of injury from the category of important ones in the camp, which threatens the life of the patient. In cases of confirming the diagnosis of the development of the internal organ, it is shown in terms of operational intervention from the irradiated physicians of the relevant profile (surgeon, urologist, obstetrician-gynecologist).

diagnosis of illness

Diagnosis is grounded on the data of anamnesis (presence of trauma), typical symptoms of pelvic malformation, radiographic examination and ultrasonography of the organs of the emptying of the cervix - to exclude the pelvic organ malformation.

up to one of the most important cases in the order of fractures of the ridge and add up to 3% of all fractures, reaching 18% in industrial areas. Mortality in case of pelvic failures becomes close to 14% of deaths, moreover, most deaths are due to blood loss.

pelvis walk around two pelvic cysts and krizhiv. Up to sixteen years, the pelvis is made up of three bones, covered with cartilaginous tissue: sidnichnoy, pubic and club. In a grown-up woman, the cysts grow up among themselves.

At the anterior part of the pelvis, the cysts join together for the help of the pubic articulation, at the back they join with the sacrum, establishing a practically unbreakable structure. On both sides of the pelvis there are deep-seated fossae - acetabular depressions - in which there are stegna heads.

The main function of the pelvis is to transfer the tension from the tuba to the lower ends. The support of the pelvis is framed with yoga stability. The pelvic bones are honed with straining m'yazami. At the empty yoga, the impersonal great and ancient vessels pass, and the pelvic nervous gossip also spreads.

Tipi poshkodzhennya pelvic ring:

1. just ushkodzhennya - ce regional uncomplicated fractures of the pelvic bones. Vіdbuvayutsya in 20% of cases;
2. disintegrating ushkodzhennya - the result of damage to the integrity of the cystic skeleton and stability of the articulation, which occurred in the last fractures and development. Fold mayzhe 80% of the ear of the pelvis. Divided into two types:

• monofocal- the injury was in the boundaries of one anatomical joint of the pelvic ring;
• polyfocal- the injury became in the anatomical veins of the pelvis.

see degree of stability of the pelvis:

1. remarkably stable to preserve the structure of the pelvic ring and the posterior shoulder;
2. unstable ushkodzhennya what is to be blamed for fractures of the posterior fibula of the pelvic ring or ruptures of the cranial-club joint with solitary lacerations of the posterior fibula or the posterior column of the acetabulum;
3. in the region of unstable ushkodzhennya are characterized by the presence of decal cavities of the pelvis in the posterior ventral crest of the anterior and posterior pivkilets of the pelvis to the displacements, including the vertical ones. Most often, the anterior and posterior limbs of the pelvic ring are damaged, the pelvic articulation is developed with fractures of the cystic skeleton.

symptoms

Before medical symptoms in case of pelvic sagging, a sharp pain, deformity of the pelvis, as well as swelling with a hematoma in the area of ​​the fracture are observed. In times of fragility of the cystic ulamkiv, crepitus (crackling) can be seen.

at anterior superior spine there is a shortening of the strokes, which viniklo through the misplaced ulama is called down to the bottom, as well as a symptom of Lodzinsky: in Russia, the legs back were not so intense, so ailments are made to walk backwards.

Fracture the upper vertebrae of the acetabulum and club cyst are characterized by a decrease in obsyagu ruhіv in the hip joint. Localization of pain will be in the area of ​​the krill of the club cyst.

at kuprik and krizhiv fractures bіl bude posilyuvatisya at palpation (method of obstezhennya ailing, foundations on dotik). It’s like a poshkodzhennya torn on the nerves, and maybe the sensitivity in the area of ​​\u200b\u200bthe seat is broken, it is possible that there is no cut and the act of defecation is broken.

at fractures of the pelvic ring without damage to the integrity vinikaє bіl in the crotch in case of fractures of the sidnichnyh cysts or in the pubic region in case of fractures of the pubic cysts.

at fractures of the pelvic ring with broken bones anterior pelvic pivkiltsya vinikaє bіl in the pelvis and perineum. Bіl posylyuєtsya with biceps and anterior-posterior pressure and rus nіg. In case of a fracture of the sidnic and upper pubic pubic cyst, the patients are more comfortable in the position of the toad: on the back, with the legs extended to the sides and bent in the knees.

at fractures of the posterior pivkiltsya ruhu legs on the side of the poshkodzhennya obmezhenі and sore.

Malgen's fractures with power, which comes with a fracture of the anterior and posterior pivkilets are characterized by pathological looseness, asymmetry of the pelvis, hematomas in the crotch area.

Fracture the acetabular trap are characterized by impaired functions of the pelvic ligament with pain syndrome; With an one-hour wivihu, the stegna will be marked by the destruction of the position of the great vertila and as a result of the violation of the position of the end.

monofocal injuries vіdbuvayutsya in the boundaries of one anatomical line of the pelvic ring. Dane's poshkodzhennya in most of the fluctuations is not accompanied by shock. Shock can develop in times of obstetric pelvic trauma with development of uterine bleeding, or as a result, the victim has survived sixty years. The severity of the injury is determined by the degree of collapse of the posterior colon and the presence of extra-pelvic injuries.

polyfocal injury vіdbuvayutsya in dekilkoh anatomical vіddіlah pelvis. Polyfocal shock of the posterior pelvic ring without displacement is not accompanied by shock. With a horizontal displacement of the rear axle, I-II stages of shock are indicated.

Shock stage I characterized by easy galvanism, however, with any contact ailments. Freedom is saved, the pulse of accelerations is up to 100 beats per whilina.

Shock stage II characterized by galvanization of the ailment, blanching of the skin curves, decreased arterial pressure up to 80 mm Hg, the pulse is more frequent up to 140 beats in the quill, resembling a weakness. Freedom is saved. On nutrition, you respond adequately, the language is upovilnena, the voice is quiet. In case of vertical susvі in the musculoskeletal stenosis of the posterior ventricle and a significant susvі half of the pelvis, shock II and III degree of severity can be expected.

Shock stage III heaviness and irrevocable. The ailment is strongly galvanized, does not react to bіl, svіdomіst is entangled or during the day, the skins are twisted bіdі, covered with cold sweat.

The pulse is rather weak, up to 180 beats in the quill, it can be counted exclusively on the great arteries. Dihannya will be superficial and part. Systolic arterial pressure below 70 mm, central venous pressure to zero. The prognosis for this stage of shock is unacceptable;

A polyfocal shock of the acetabular pit behind the shock of the anterior colony or the bottom in the bottom of the shock of the anterior pivkiltsya is not accompanied by shock. If the anterior colony is broken in the same time as the bottom fractures, it can be aggravated by stage I shock, the anterior and posterior colonies are aggravated by stage II shock.

With the appearance of the ears with a dislocated half of the pelvis, shock of the III degree of severity is expected.

cause

The cause of the pelvic ear is a strong direct trauma. Road traffic accidents should be over 50%, falls from heights - more than 20%, virobnic injuries - more than 10%. Okremo see a fall from the height of damp growth in summer people - close to 11%.

The widest mechanisms of pelvic urticaria:

• a direct rear blow, which brings the name of the krill of the club brushes to the turn and the opening of the pubic ring of the pelvic brushes. It can also be used to open the front krizhovo-club links. This type of fracture is called the fracture of the “Open Book”;
• direct frontal blow, which leads to a bilateral fracture of the pubic and sidnic cysts. Anterior-posterior compression is possible. This type of fracture is called "Fracture of the naznik";
• lateral compression, as in the case of a fracture of the biceps masses of the pelvis, a fracture of the anterior pivkiltsya, rupture of the posterior krizhovo-club ligaments, with which the ligaments of the pelvic floor may not be broken;
• the name of the turn and the introduction of the most often blamed for motorcycle injuries. In case of any mechanism of injury, it is possible to blame the nadvazhkіy poshkodzhennya - injuring half of the pelvis;
• vertical compression - gazing displacement, which is due to falling from height.

jubilation

diagnostics:

1. Consultation of a traumatologist, surgeon.

2. Instrumental diagnostics

• radiography in direct, caudal, obturator and club projections;
• computerized tomography (method of ball-by-spheric rotation of the internal structure of the object);
• magnetic resonance imaging (method of investigating internal organs and tissues from victoria to the physical manifestation of nuclear magnetic resonance).

persha dopomoga in case of pelvic fractures, it includes obov'yazkove nebolyuvannya, negayny vyklik shvidkoy to help and supine the injured position "toad": lying on the back, bending down under a 45º kutom in knee and pelvic folds with a small separation to the sides. Under the knee, a roller is placed from a burnt carpet, clothes, etc. Transportation of the sick person is carried out without changing the position on the board.

jubilation in the most important vipadkіv operatively and to fall in the type of poshkodzhennya.

zabіy(Latin contusio) - close, so as not to be accompanied by a wound, skins, tissues and organs without damage to their structures. Tse means that when struck, it does not break or break the tendon, ligaments, ligaments and other soft tissue structures. Zabіy can suprovodzhuvatisya poshkodzhennyam blood-bearing vessels, which, in his line, led to hematoma, so that the true pooling of blood in the emptiness after injury or sinci (sinciv), if the tissues are clogged evenly seep blood. The blue in the middle of the blow sounds manifested by a blue-red flame, zabarvlennya some kind of step-by-step for a sprat of tyzhniv changes to green and yellow. If you talk about blows to the pelvis, the hip joint and the upper part of the joint, thenoften suffer soft fabrics over the brush ledges. Most often, it strikes in the area of ​​the great trochanter of the stehnic cyst - the most protruding cystic illumination on the stegna, but the blow can also be in the area of ​​the crest of the club cyst, soft pubic cyst, sydnic tubercle or on all fronts new-old surface quilting.

Reason for hitting velmy banal - a blow, which occurs during a fall, closure in sports, road transport, accidental injuries, etc.

Basic scarga- beat in the mist of the blow. In case of building a collapse of the leg through the presence of the damaged structure of the m'yaziv, the tendon, the ligament is saved, but it can be even more sore.

jubilation mainly aimed at relieving pain and reducing strength and frailty in the gloom until quiet pіr, until the symptoms appear. With this, it is important to turn on other, more unsafe poshkodzhennya, about which we will talk below.

can be folded- subfascial hypertensive syndrome, osmotic myositis.

Typical places for impacts to develop in the area of ​​cystic projections: front view

diagnosis

The diagnosis of a blow to the pelvis, stegna, pelvic stump may not be so simple as it is, so as with blows, it can be seen even more, the name is not memorable. Let the doctor know about those, how the injury has become. After which doctor proceeds to look around. Bol in the field of impact is strengthened by the onslaught and by the pressure of the adjacent m'yaziv. In case of blows in the area of ​​the sydnic tubercle, the boulevard is surrounded only by the rear group of m'yaziv stegna, and in case of blows to the front surface of the stegna, it is surrounded by the chotyri-headed m'yaz stegna. Shards may be all roztashova here m'yazi zadiya when walking, then sound sings of culture.Mozhlivy nabryak or pіdshkіrnі bloody. Sometimes it is blamed for passive leg collapses, then it is not the same if the patient collapses with his foot independently, and if the patient's leg collapses the patient. With passive movements in singing positions, the affected soft fabrics are stretched, or the mud lay down to them, which causes pain to the point of exacerbation. Thus, blows in the region of the club crest are accompanied by pain with active and passive adduction of the stegna, and blows to the anterior surface of the stegna are painful with active expansion of the hamstring and folded stegna.

Additional diagnostics may be needed to rule out more serious problems.The victim is to carry out radiography, which allows to inspect the blows in the fractures visible on the radiographs. In the first line, it is necessary to include fractures of the head of the steg cyst, the edge of the acetabular depression, fractures of the neck of the steg cyst (fracture of the neck of the steg), trochanteric region.

Of the other methods of advanced diagnostics, only magnetic resonance imaging provides valuable information. Z її help to detect hematoma, Morel-Lavallée syndrome (traumatic fracture of the skin and subcutaneous fat cells), tearing of the m'ulcer, rupture of the subglottic lip, stress fracture of the neck of the stenocyst and other others no fractures, missing one hour of radiography. However, magnetic resonance imaging is used, as a rule, not immediately, but only once, if the most conservative treatment does not give clear results.

There are no special diagnostic tests for strokes. However, there is still a strong swelling, especially at the upper part of the steg and in the middle of the seat, it is necessary to perekonatisya, so as not to develop subfascial hypertensive syndrome(In addition, it is like a case syndrome), so that there is no infringement of the affected areas in their cystic-fascial beds. For whom vimiryuyut vice in tsikh lodges. According to a number of recommendations, moving the subfascial grip up to 30 mm Hg. Art. or to equal less than 30 mm Hg lower. Art. below the diastolic blood pressure, serve as indications before fasciotomy - surgery, and as a way to cut the fascia, which lowers the pressure in the middle of the fascial case. It is necessary for the mother on the uvazі, scho to induce with such a high subfascial pressure, the vicissual tactic gives good results in a number of vipadkіv.

aggravation

Compounded blows rarely rіdko. One of such complications is the development of subfascial hypertensive syndrome, which is accompanied by fibrosis of the ulcers (incremental replacement with good tissue) and a decrease in the amplitude of the damage. The more it is possible to aggravate - the development of ossification of myositis, I will become, when in the middle of the m'yazyv ossifikats are settled, that is the cause of ossification, ossification. For the prevention of ossification of myositis, an early mobilization (necessary movement) of the injured and living is carried out, in order to change the development of hematomas. Formed hematoma can be known in the end of the chest and work well on roentgenograms and computer tomograms. In the form of soft tissue sarcomas, a roentgenological picture and the presence of trauma in the past can be seen. Osifikyuchy myositis develops in a precentral direction: a belt of calcifications settles on the back, which then expands in the middle. If myositis doesn’t call out scarg, you can’t fight for new respect; if the wines are accompanied by pain or significant changes in the soil in the swamps, then the new creations of the stone mass after ripening are seen by the surgical path. Dozrіvannya ossifikati vіdbuvaєtsya protyagіlkoh міsyаціві і most likely vyznaєtsya for the aid of a special diagnostic method - scintigraphy.

Ossifying myositis. Dilyanki m'yaziv "ossified" after the downtrodden

It is important to guess one more important camp, as not to complicate the slaughter, but rather a special form of impact - the Morel-Lavallée syndrome (traumatic injury to the skin and subcutaneous fat cells). Tsey syndrome is dedicated to the okrema article on our website.

jubilation

In the most important cases of slaughter of the pelvis, pelvis and pelvis, the pelvis is successfully rejoiced conservatively, that is, without surgery.The meta of conservative exuberance lies in the fact that the yakomoga can better restore the amplitude and strength of the rupture in a clogged nose. Celebrations begin with conservative approaches to fight against more and more trouble. Here you can see calm, cold compresses and non-steroidal anti-inflammatory drugs (Voltaren, Xefocam). Like standing or walking, shouting bіl, you can speed up the police. After 1-2 dobies, they begin to restore the fragility of the legs with the right to passively stretch the muscles. It is possible to start exaltation of the stretching of the injured m'yazyv, for which it is necessary to carry out immobilization of the leg in a supine position - for example, when hitting the upper part of the chotirigolous m'yaza of the quilt, often fix the knee joint in a bent position. At the same time, in the case of the suffering of the affected m'yazіv, they assign the right for the treatment of the otochuyuchih m'yaziv. Gradually, the strength and rigor of the legs are restored, and the patience turns to sports.

surgical treatmentwhen struck, it is not necessary to sound. Rarely, in rare cases, it is possible to open a hematoma, or to carry out a fasciotomy in a ligament with a subfascial vice.

A strong pull and the ineffectiveness of conservative exuberance point to the possibility of a large hematoma, which can transcend a swift blow. In such cases, an MRI is performed and, according to the results, there is evidence of drainage of hematomas.

forecast

The prognosis for more strikes is susceptible, proteit’s important to say, how much time is needed to renew after the blow. It is worth to lie down depending on the situation and the severity of the slaughter and the characteristics of the body.

prevention

In young strike inevitably accompanies you to take up sports, especially such hard yoga types, like American football, hockey or rugby. It’s hardly possible to get rid of them, but some of them can be hidden behind the help of a wicked order. Hockey players, for example, wear special shorts to protect the pelvis and hips from injuries; similar shorts with sewn-in shields pull on the weight of American football. The other parts of the shoulder harness, for example, shoulder pads, reduce the resistance to the impact of the pelvis and the leg at the other grave when closing it. An important factor can also be the surface of the playing field. So, the main idea (not supported, vtim, previous tributes), that when grilling on grass, there are less hits, lower when grilling on piece cover.

Years old strike as a rule they trap when they fall. Clean up the kilimki and lie on the bed of the electric darts, de Vie will walk. There is no way to tidy up the kilims with the help of logs, follow up so that the kuti did NOT die. Double-sided adhesive tape can be glued to the lower surface of the kuta kilim. Walk through your apartment or house together with your relatives as a "search" or fakhivtsya for safety: clean up or glue the little pieces of all kilimkiv with double-sided tape, so that you can’t talk about them. If you have parquet in your house - turn over all the boards so that you don’t fall out of them. If the fall in the fire is often taken down due to various reasons, then it is more important for them to pay special respect to safety. Reveal that a “child” is to blame for your booth in the plan for moving around the apartment: plan it in such a way that it will be trimmed for it (but the support is to blame for the stand, and not the plastic bookcase) and do not stumble about it. Paste over the hospitality tables and other furniture with special soft pads (sold in children's stores). Be sure to provide normal lighting for all applications and cloaks in your home.

At the preparation of the article, the following materials were won:

Anderson Do et al: Hip and groin injuries in athletes. Am J Sports Med 2001; 29(4):521.

Diaz J A et al: Severe quadriceps muscle contusions in athletes. A report of three cases. Am J Sports Med 2003; 31(2):289.